Abstract

OBJECTIVESTo evaluate a clinical pathway of discharge on postoperative day 3 for the tension-free
vaginal mesh (TVM) procedure in patients with pelvic organ prolapse (POP).METHODSBetween May 2006 and December 2007, 305 consecutive women with POP quantification
stage 3 or 4 were planned to undergo the TVM procedure in a single general hospital.
Excluding five patients with concomitant hysterectomy, a pathway (removal of the indwelling
urethral catheter on the next morning, discharge on postoperative day 3) was applied
to the remaining 300 patients. The perioperative complications and postoperative hospitalization
were prospectively evaluated in this case series.RESULTSPerioperative complications were: bladder injury (11 cases, 3.7%), vaginal wall hematoma
(two cases, 0.7%), rectal injury (one case, 0.3%) and temporary hydronephrosis (one
case, 0.3%). None needed blood transfusion. The indwelling urethral catheters were
removed on the next morning as in the pathway in 287 cases (95.6%), and none required
clean intermittent catheterization at home. Postoperative hospitalization was within
3 days in 280 cases (93.3%). The six cases (2.0%) with longer hospitalization were
due to complications (two cases of bladder injury, one of rectal injury, one of blood
loss over 200 mL, one of temporary urinary retention, and one of hydronephrosis).
Two patients were re-hospitalized within one month due to vaginal bleeding or gluteal
pain.CONCLUSIONSPatients generally accepted the pathway of discharge on postoperative day 3 in spite
of the Japanese culture preferring a longer hospital stay.